Endometrial sampling using the Pipelle device is widely used in the UK especially in the investigation of postmenopausal bleeding. This study was aimed at evaluating the clinical benefit and diagnostic accuracy of the procedure in the setting of a dedicated one-stop clinic for women with postmenopausal bleeding. The study also examined the factors that would affect the adequacy of endometrial samples in terms of their suitability for histopathalogical examination. Data from 97 consecutive patients attending the clinic were collected and analysed. All the patients had a transvaginal ultrasound scan and an endometrial Pipelle sample was attempted unless refused by the patient. The analysis revealed that the procedure avoided the need for hysteroscopy in 61.5% of cases with an endometrial thickness of > 4mm. No cases of endometrial cancer were missed after successful Pipelle sampling. The ability to obtain an adequate endometrial sample was primarily affected by the endometrial thickness. There is only a 27% probability of getting an adequate endometrial sample in the group of women with an endometrial thickness of < 5 mm. The study recommends this procedure for the group of women with an endometrial thickness of > 4 mm. However, when the endometrial thickness is < or = 4 mm, little can be gained from endometrial sampling as malignancy is rare and the chance of getting an adequate sample is small.

Oligohydramnios at term in the absence of maternal and fetal complications poses a dilemma in management. It is one of the major indications for antenatal surveillance and induction of labour. There is a growing body of evidence that oligohydramnios in the absence of maternal or fetal risk factors ('isolated' oligohydramnios) is not associated with an adverse perinatal outcome. In this study, we surveyed the management of isolated oligohydramnios at term in a tertiary referral maternity unit. Out of 92 women who were scanned at term, 22 (24%) women had isolated oligohydramnios. A greater tendency to intervene in such cases was noted with 10 (45%) women having labour induced, while one (4.5%) had an elective caesarean section. Emergency caesarean section rates were also higher in the oligohydramnios group (13.5%) than in a low risk group (6%). There was no increased perinatal morbidity when compared with pregnancies managed expectantly.

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Uterine artery Doppler waveform analysis is not offered in routine antenatal care in the UK. The aim of this study is to evaluate a policy of offering uterine artery Doppler ultrasound, in the setting of a District General Hospital, to women who are judged to be at high risk of adverse pregnancy outcome, based on their mid-trimester biochemical serum screening. Data from 73 cases with abnormal serum screening were collected and analysed. Abnormal outcome occurred in 11 cases (16%) including two perinatal deaths. The positive predictive value of adverse outcome was 13% for abnormal serum screening, 26% for human chorionic gonadotropin (hCG) >3 multiples of the median (MOM) and 8% for alfa-fetoprotein (AFP) >2.5 MOM. A total of 56 cases of the study group had uterine artery Doppler at 22 weeks' gestation. Evaluation of the performance of uterine artery Doppler in prediction of adverse pregnancy outcome revealed a sensitivity of 43%, specificity of 70%, a positive predictive value (PPV) of 18% and a negative predictive value (NPV) of 89%. When the presence of diastolic notch was taken to define a positive result the sensitivity remained unchanged, however the specificity, PPV and NPV improved to 91%, 43% and 91%, respectively. In conclusion, the combination of serum markers and abnormal uterine artery Doppler ultrasound improves the identification of women at risk of subsequent pregnancy complications. Raised serum hCG has a better predictive value for adverse pregnancy outcome as opposed to raised serum AFP. In the absence of diastolic notch, the accuracy of abnormal uterine artery Doppler ultrasound is markedly reduced.

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